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US health care: There must be a better way — or several

A doctor reads a blood pressure gauge during an examination of a patient at the Codman Square Health Center in 2006.
A doctor reads a blood pressure gauge during an examination of a patient at the Codman Square Health Center in 2006.Joe Raedle/Getty Images

Insurers’ profit motive makes it hard for his patients to get care they need

In “Getting sick and going broke” (Opinion, Dec. 16), Drs. Steffie Woolhandler and David Himmelstein nicely illustrate the insidious ways that health insurers turn a profit by refusing to pay for needed services, and they highlight the astoundingly high numbers of Americans who end up filing for bankruptcy because of medical bills.

My greatest impression of insurance companies is that their profit motive makes it hard for my patients to receive the care they need.

One way insurers profit is by not maintaining accurate lists of providers who are in their network and accepting new patients. I’ve conducted several studies and found numerous wrong numbers and full practices — and physicians who simply never return phone calls— such that even those with good insurance often are unable to schedule medical appointments.


Another thing insurance companies do is to require time-consuming prior authorizations for certain services in hopes that clinicians will be discouraged from trying to access those services. In two separate studies that colleagues and I have conducted, the average amount of time mental health clinicians spent on the phone with insurance representatives in order to hospitalize depressed and suicidal individuals, among others, was 50 minutes.

As recently as Tuesday I spent a total of 70 minutes on the phone obtaining authorization for a single sleep medication for one of my patients. I would have hung up early in the call, but my patient was desperate to sleep, and nothing else we’d tried has worked.

Insurers have no incentive to ensure that people receive timely, needed care, and they ought to be removed from the picture. We would all be much better off if health insurers were replaced by a not-for-profit system whose sole motivation was to get people the care they need and not bankrupt them in the process.


Dr. J. Wesley Boyd


The writer is affiliated with Cambridge Health Alliance is an associate professor of psychiatry at Harvard Medical School.

Universal billing would be a start, national health care would be a goal

Fixing the broken health care system in the United States will be a complicated process, and it will disrupt current health care business models.

A good first step in improving health care is to implement a universal billing system for all health care encounters. This would include one process with the same billing forms and one set of billing codes for all health care services. Universal billing would enhance transparency in health care financing, improve understanding of health care expenses, and allow better analysis and comparison of health care costs.

In our opinion, the best long-term fix for health care in America is to replace national health insurance with national health care. As we have learned in this Globe series, health insurance is not the same things as health care.

An “AmeriCare” system could be a partnership of health care professionals, hospitals, and government in a new health care enterprise. The new organization would be based on the model of integrated group practice, where all members of the group work in the best interest of patient care. AmeriCare would utilize current revenue streams, reduce medical expenses, eliminate insurance profits, and improve health care.

Dr. Angela C. Healy


Dr. William L. Healy


Parenting education and support has to be a priority

Health care, rather than “disease care,” must include parenting education and support. The Collaborative for Healthy Parenting in Primary Care, part of the National Academies of Sciences, Engineering, and Medicine, is leading the way in advocating for these resources. As parents, we need three things: knowledge about child development, skills in providing guidance appropriate to each child’s age and stage, and, most important, encouragement — that is, emotional support — for ourselves in acquiring and using that knowledge and those skills.

Those tasks must be accomplished, of course, while we juggle other responsibilities: paid work, community involvement, care for our own parents, and care for ourselves. Once parenting resources are normalized, then the stigma — that such services are for those considered at risk in some way, or for those who themselves have problems or whose children have problems — will be erased.

Parents need positive, preventive resources at each stage of their children’s growth and development. These services must be made available, accessible, affordable, and attractive for all. They can and should be offered at the workplace, in schools, and through medical practices, houses of worship, and sports leagues — wherever parents meet.

Eve Sullivan


The writer, a member of the collaborative, is the founder of Parents Forum.

Envisioning a market-based approach, without third-party payers

I see the future health care system relying less on third-party payers, such as insurance companies, and adopting more of a market approach, where health care systems like Beth Israel Lahey Health, UMass Memorial Health Care, and Partners HealthCare compete on price and quality.


In such a market, these systems would charge individuals a monthly membership fee. In return for the fee, members would be covered from soup to nuts, ranging from preventive care to transplants. If a member doesn’t get adequate care at their provider, they get re-treated at no further charge, other than the monthly fee. People who are unhappy with their care would be free to find another system.

The monthly fee would serve as the revenue source for these health care systems. The competition for members would drive down costs and increase quality.

Mike Elia

Erie, Pa.